An accessible approach to tackling chronic diseases

Robust partnerships are crucial to delivering access to medicines in low income and fragile environments, report Martin Banks and Brian Johnson.

From L to R: Novartis Access' Anthony Gitau, Esperanza Martinez from the Red Cross, Jan Paehler from the European Commission's DG DEVCO, MEPs Cristian Dan Preda & Lieve Wierinck, Robert Bett from the Kenyan Red Cross & Richard Jones, Partnerships editor at Devex | Photo credit: Novartis and the Kenya Red Cross


Romanian EEP group MEP Cristian Dan Preda has called for the international community, including the EU, to "step up efforts" to help fight the spread of non-communicable diseases in developing countries.

Non communicable diseases, or NCDs, kill 38 million people each year. Almost three quarters of deaths - 28 million - occur in low and middle-income countries.

Some 16 million NCD deaths occur before the age of 70 and 82 per cent of these "premature" deaths occur in low- and middle-income countries.

It is against this backdrop that leading global pharmaceutical company Novartis organised a high level debate in the European Parliament on the subject of 'Innovative Partnerships for Chronic Diseases'.

The aim was to help find new ways to improve access to medicines in "fragile" communities such as Kenya and other African states.

Speaking at the event on 9 November, Preda, an EPP group member, said all parties should make their development actions "as effective as possible" so as to make the best use of public and private resources.

"Now, more than ever, we should think about innovative partnerships that bring together all development actors," declared Preda, a staunch advocate of the need for all stakeholders to find ways to work together to tackle the burden of both infectious and non-communicable diseases.

The meeting was particularly timely as it took place shortly after Parliament's development committee had discussed an opinion drafted by Preda on the links between intellectual property rights and access to medicines in developing countries.

Preda, one of several keynote speakers at the breakfast roundtable, said that, currently, some of the barriers to accessing medicines in developing countries are lack of proper legislation, limited infrastructure, poor quality pharmaceuticals and weak pharmaceutical policies.

Other obstacles include poorly managed distribution and supply chains, insufficient training and shortages of health workers.

He added, "This suggests that the issue needs to be seen in a broader context, and I think our efforts should be to build a holistic approach that seeks to improve developing countries capacities and help them design working health systems that aim to improve access to services, particularly for vulnerable communities."

Preda went on, "We should also be more nuanced and recognise the crucial link between intellectual property rights and innovation. We should also develop local capacities in terms of pharmaceutical research and medicines production in developing countries themselves."

Another speaker was Robert Bett, public health manager at the Kenya Red Cross Society, where he is in charge of technical oversight and support in the area of non-communicable diseases, reproductive and maternal health and new born health.

He told the audience, comprising MEPs and stakeholders, that the burden of non-communicable diseases is increasing in low and middle income countries with "devastating economic consequences to families and communities."

NCDs, he noted, have become the leading cause of death worldwide, overtaking the causes due to communicable diseases, and the NCD burden affects people in the most productive age group (30–70 years).

He pointed out that time taken off work to seek treatment and care results in decreased productivity and loss of income and households are "trapped in poverty" as family members increase out-of-pocket expenditure to offset medical bills of these lifelong illnesses.

Providing an insight into the current situation on the ground in Kenya, Bett said, "NCDs have become an epidemic in our population. But we have a health care system that is still struggling to cope with infectious diseases and other conditions and is therefore not prioritising NCDs.

"NCDs play a critical role in reducing household resilience and therefore community resilience to emergencies and disasters as they are draining the household income."

His comments were echoed by another speaker, Esperanza Martinez, head of health for the International Committee Red Cross, who said, "Humanitarian crises are no longer contained or restricted to certain environments.

"They have a global impact. Therefore, in relation to chronic conditions, there is a need for concerted global and regional efforts to provide a continuum of care for NCDs."

Traditionally, she said, the management of chronic conditions has been "viewed from a developmental model."

Martinez, a doctor and general surgeon with over 10 years of experience working in conflict-affected regions, added, "In contexts of fragility, there is a need to use a humanitarian approach, focused on the individual needs and reality. This might include providing a package of services at first encounter, medications supply for longer periods and different approaches to prevention and screening."

Jan Paehler, of the European Commission's DEVCO directorate, outlined the efforts the EU was currently taking to tackle the issue, saying it had committed €4bn in 17 countries to tackle NCDs and had invested a further €1.4bn on other related global initiatives.

A medical doctor who spent five years in Ghana before overseeing government grants, Paehler added, "But this whole issue is also about prevention. This, in the long term, is more effective than just focusing on treatments alone."

Also participating was Anthony Gitau, who is in charge of implementing and scaling up Novartis social business programmes in Kenya and who has more than 15 years of experience in the pharmaceutical sector in eastern Africa.

Gitau spoke passionately about Novartis' Access Programme, an innovative initiative targeting four major non communicable diseases that combined contribute 82 per cent of NCD deaths globally.

He described the growing NCD burden as a "double tragedy" for low and middle income countries as they grapple with the existing burden of communicable diseases and the growing problem of NCDs.

"Novartis Access offers a portfolio of 15 on and off patent medicines for breast cancer, cardiovascular disease, diabetes type 2 and respiratory illness at a price of US$1 per treatment per month to governments and NGOs which will reach the patients at a price of about US$1.5 in Kenya," he said.

"We are working with partners on the ground to minimise mark ups and ensure treatments reach the right patients via the right channels."

The programme, he said, was first launched in Kenya in October 2015 and is targeted to reach 30 low and middle income countries over the coming years.

He said, "One of the key early lessons of Novartis Access is that affordable drugs alone are not the only answer. There needs to be robust partnerships to ensure proper patient management."

Novartis Access, he noted, has entered into three "capacity building" agreements with the Kenya Red Cross Society, the Kenya Conference of Catholic Bishops and the Christian Health Association of Kenya.

He added, "However, there needs to be a concerted effort to support the whole ecosystem around NCDs. The EU's leadership and focus on NCDs will hopefully lead to a reprioritisation of NCDs in the national agenda, policy and budgeting of low and middle income countries. We need to learn from infectious diseases.

"To fight NCDs we need to leverage the existing health system infrastructure of HIV, TB and malaria to have a more integrated approach and optimise health care systems in the countries."

He said, "The Access Programme has proved to be a great initiative but it remains only one piece in the puzzle. More pieces are needed before we can say we have truly achieved something concrete."

The event was moderated by Richard Jones, partnerships editor of Devex, a media platform for the global development community.

He hoped the meeting would help put the issue of access to medicines "front and centre in our minds as we go about our day-to-day business as policymakers, business leaders, and civil society activists."

Jones concluded, "It's only by working together - across party lines, across sectors - that we'll be able to address some of the underlying issues we've heard about today, such as the lack of health care infrastructure, the shortages of trained professionals, out of pocket expenses, and weak distribution channels."

Closing the event, Belgian ALDE group deputy Lieve Wierinck thanked all the speakers and praised the Novartis Access initiative saying, "We can clearly see that health needs are shifting as non-communicable diseases grow in low- and middle-income countries."

"Because chronic illnesses and cancers require early detection and long-term, ongoing treatment, we need to find new ways to ensure access to medicines for NCDs in regions that are disproportionately affected."

Wierinck warned that no single organisation could solve the NCD access challenge alone, but that each actor involved in the issue, could make a significant contribution.

"Partnerships are crucial to raising awareness of NCDs in those countries, and I applaud every act of benevolence and philanthropy. However, it is clear that donations alone are not enough. They are not scalable enough to make a lasting impact over all. Therefore, new approaches such as Social Business models are needed."

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